Splenic injury following diagnostic endoscopic retrograde

G. La Greca, t P. Fisichella, t L. Greco, ~ A. Di Stefano, ~ D. Russello, I F. Latteri 2 L First Surgical Clinic, University of Catania, Catania, Italy 2 Emergency Department, Ospedale "Cannizzaro", Catania, Via Messina 829, Catania, Italy Received: 14 January 2000; Accepted: 15 June 2000; Online publication: 20 October 2000 DOI: 10.1007/s004640040027 Abstract We used a new technique to treat a right-sided Morgagni hernia in a symptomatic adult with a transverse colon that was herniated in the chest. Three trocars were required. The herniated viscera were easily reduced in the abdomen, and the diaphragmatic border that was mobilized from the liver showed the elliptical diaphragmatic defect (9 x 5 cm); however, the hernial sac was not resected. Four transversal 1-cm cutaneous incisions were made just below the costal arch. Using a Reverdin needle holder, we introduced eight ligatures under laparoscopic control through the abdominal wall and through the free diaphragmatic border. Each suture was then held by the grasper and freed from the Reverdim After the Reverdin was extracted and reintroduced more caudally, the intraabdominai suture was placed into it and finally extracted again. Before knotting, all the sutures were pulled together to achieve perfect closure of the defect. A suction drain was placed in the hernial sac. The duration of the procedure was 12 min. The patient was discharged on the 5th postoperative day. A review of 20 other patients treated via a video-assisted approach is also included here. We found this original technique to be extremely simple, rapid, and effective. It can also be performed by surgeons who are not specially trained in intracorporeal suturing and knotting and can probably also be used for the repair of other types of diaphragmatic defects. The use of laparoscopy and magnification allows the surgeon to achieve a better point of control for simpler solutions.